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Workers' Comp: FAQs

1) What is the amount of attorney fees in a workers' compensation claim?

There is no charge for the initial consultation in a workers' compensation claim. Attorney fees are payable on a "contingency basis." This means that if there is no recovery there is no fee. The attorney receives a percentage of the settlement or award at the end of the case. If a person chooses to be represented by an attorney, the attorney fees will be deducted from the settlement at the end. Attorney fees are normally 15% of the benefits awarded.

2) Am I entitled to other benefits?

If you have an injury or illness serious enough to prevent you from returning to work, you may be eligible for Social Security disability if you have been off work for 5 months or more. To qualify, you must have paid into the Social Security system in 20 of the last 40 quarters, and are likely to be off work one full year or longer. If you feel this applies to you, contact an attorney for more information.

Public employees who have retirement programs other than Social Security, may be eligible for disability benefits under the Public Employee Retirement System (PERS), State Teachers’ Retirement System (STRS) or county, city or other retirement systems. Under certain situations you may also be eligible for State Disability Insurance, Unemployment Insurance, Long Term Disability etc.

3) The insurance company is providing all benefits, should I wait to hire an attorney?

Unfortunately, many injured workers wait until it is too late, or a crisis has occurred, before they consider hiring an attorney. The injured worker should consider the following facts:

The insurance company's interests are not the same as those of the injured worker.

The workers' compensation system is highly complex, with many procedural requirements and time limitations.

The insurance company has attorneys who represent their interests regarding the extent of your workers' compensation benefits.

If an injured worker retains an attorney, there is no charge for the interview or for any services along the way. The attorney fee is 15% on all cases.

Injured workers usually consider retaining an attorney if they feel they are at a disadvantage in dealing with the insurance company, or any time that benefits are being denied. An injured worker should also consider having an attorney when they are going to have a need for continuing or lifetime medical care, or if they are going to end up with a permanent disability.

If a worker has a permanent disability but does not have an attorney, they are required to select a doctor off of a three doctor panel. The claim will be resolved based upon that doctor's report. Unfortunately, if the worker does not agree with this doctor's opinion, they do not then have the right to get a second medical opinion. Essentially, the injured worker is stuck with that doctor's opinion. However, if the injured worker is represented by an attorney, the attorney can refer the worker to any qualified medical examiner. The attorney can select a doctor who will listen to all of the symptoms of the injured worker and prepare a report for the injured worker, not the company.

If the injury was caused by the negligence of someone other than the employer or a co-employee, an injured worker should consult with an attorney as soon as possible following an injury. In that case, an injured worker may have the right to bring a personal injury action in addition to a workers' compensation claim. There are strict time guidelines in which a claim would have to be brought. Merely because a person is continuing to receive workers' compensation benefits does not mean that the statute of limitations against the negligent party does not run. As a result, it is extremely important that an attorney be consulted in those types of cases.

4) What Is the Statute of Limitations?

If you are injured at work, you must file for Workers’ Compensation within the Statue of Limitations, which are strict time limits set by law. Although there are many exceptions, the Statute of Limitations generally is one year from the date of injury. If you delay, or fail to report a work-related injury or illness, no matter what kind or how severe, your benefits may be delayed or denied. Because changes in the law have become effective different times, there may be different time limits depending on the date of injury.

During your case, you will receive notices from your employer. You must respond to these notices before the deadline, or benefits may be severely affected. There are many exceptions to the Statues of Limitations in Workers’ Compensation. If in doubt, consult an attorney.

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Legal Notice

Filing a false or fraudulent workers’ compensation claim is a felony subject to up to 5 years in prison or fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment & fine.